Alliance Alert: Yesterday, Governor Hochul announced her $252 Billion state budget proposal which included provisions to improve affordability, increase housing stock, and address the growing mental health crisis. The proposed budget included funding for critical services the Alliance has long advocated for, including establishing a Hospital to Community Peer Bridger program, creating up to 7 new Clubhouses, and adding new INSET teams. However, we were disturbed to see a focus on increasing involuntary inpatient and outpatient commitment. While recent tragic incidents have spurred calls for increased forced treatment, these proposals will do little to address the root causes of the current mental health crisis which has left many people in need of services and struggling to find permanent housing.
We know how to help people who have major needs through successful engagement programs like INSET and many other innovative outreach teams the Governor and Legislature have funded over the last few budgets. The Alliance and other advocates will continue to call on the Legislature and Hochul Administration to invest in proven service solutions while improving our systems’ coordination and accountability using Incident Review Panels. We will also advocate for the legislature to include other major programs, like Daniel’s Law Mental Health first responder teams and passage of Treatment not Jail legislation, to ensure New Yorkers get the support they need when experiencing a crisis and stop the revolving door of jail stays.
The Alliance is also appreciative of the Governor’s office including a 2.1% Cost of Living Adjustment in her proposal, but much more is needed to address workforce shortages and rising operational costs for our essential agencies. We are calling for a 7.8% rate enhancement for mental health and substance use agencies alongside critical investments. We will continue to advocate for what we know our system needs as the legislative session and budget negotiations continue. You can join our efforts by attending our upcoming forums and legislative day on March 4th. See below for more information, including responses to the proposals from the Alliance’s CEO, Harvey Rosenthal, and stay tuned for additional analysis of the proposed budget.
Critics Say Hochul’s Plan to Expand Involuntary Commitment Doesn’t Address Root Issues
By Briana Supardi | CBS 6 News | January 20, 2024
ALBANY, N.Y. — As Governor Kathy Hochul prepares to unveil her budget bills, one proposal is already igniting controversy: her plan to expand involuntary commitment for those with severe mental illness. The proposal aims to broaden the criteria under New York’s Mental Hygiene Law, allowing authorities to intervene earlier when individuals cannot meet basic needs like food or shelter, even if they are not imminently dangerous.
“This is about having the humanity and the compassion to help people incapable of helping themselves, fellow human beings who are suffering from mental illness that is literally putting their lives and the lives of others in danger,” Hochul said during her State of the State address.
She emphasized the need for major reforms to strengthen New York’s involuntary commitment and assisted outpatient treatment laws to ensure vulnerable adults do not fall through the cracks.
“We cannot allow our subway to be a rolling homeless shelter,” Hochul said. “We need to expand involuntary commitment into a hospital to include someone who does not possess the mental capacity to care for themselves, such as refusing help with the basics: clothing, food, shelter, medical care.”
However, critics argue that expanding involuntary commitment could do more harm than good.
“This has often been the knee-jerk reaction that groups have when there are times of crisis or tragedy, and it’s a false solution. It hasn’t been proven. It doesn’t really get the job done. It doesn’t answer why we have people on the street,” said Harvey Rosenthal, CEO of the Alliance for Rights and Recovery.
While Rosenthal applauds the governor for making investments in mental health care, he warned that forcing people into treatment without addressing systemic issues like housing will only exacerbate the problem.
“They’ll tell you the damage and the trauma and the fear that coercion really caused them. We don’t have to engage people out of fear,” he said about people who have been involuntarily committed.
Instead of short-term solutions, Rosenthal urged the state to focus mental health care resources on long-term plans. “They’ll work a lot more and for longer than just hauling people away into hospitals, thinking somehow that’s going to get them food, shelter, and clothing,” he said.
Governor Hochul stated that she has already invested $1 billion in mental health to transform care across the state. With her budget bills set to be released on Tuesday, all eyes are on how much funding will be allocated to these proposals.
Critics say Hochul’s plan to expand involuntary commitment doesn’t address root issues
Hochul’s Medicaid Budget continues to Swell
By Amanda D’Ambrosio | Crain’s Health Pulse | January 22, 2025
Gov. Kathy Hochul’s executive budget plan estimates large increases in the state Medicaid program, a measure that some fiscal watchdogs say is not sustainable.
Hochul’s $252 billion budget proposal, released on Tuesday, allocates $35.4 billion for the Health Department’s Medicaid budget, a 14% increase from last year. However, the state’s financial plan lacks accompanying policies to tamp down ballooning Medicaid costs, running the risk that those costs will run the state into a deficit.
“There’s a ton in new spending, but not a ton in new policy,” said Patrick Orecki, director of state studies at Citizens Budget Commission, a nonprofit watchdog that analyzes fiscal policy. He said that the governor’s proposed budget lacks a previously promised savings plan to address Medicaid spending, adding that cost reductions will most likely come from limiting eligibility.
Persistent growth in Medicaid spending is largely driven by increased enrollment in public health insurance programs, State Budget Director Blake Washington said in a briefing on Tuesday. There are approximately 7 million New Yorkers enrolled in Medicaid, which is 900,000 more than from before the Covid-19 pandemic. Along with enrollment in other public insurance plans such as the Essential Plan and Child Health Plus, New York covers approximately 9 million people, Washington said.
High costs within the managed long-term care sector – which includes home care – have also fueled high Medicaid costs, Washington said. The state has tried to mitigate long-term care spending by consolidating the Consumer Directed Personal Assistance Program, a home care program that allows recipients to hire and train their own caregivers. But managed long-term care enrollment is still projected to grow 12% in the coming year, adding pressure to the state budget, Washington said.
The state plans to ease some of its health budget challenges with revenue from a new tax on health insurance companies that’s expected to bring in $3.7 billion. New York’s managed care organization, or MCO, tax was approved by federal health officials late last year and allows the state to take advantage of a tax loophole that drives up federal reimbursements. Hochul said that the state will spend the $3.7 billion over three years to enhance rates for hospitals and nursing homes, offset spending increases and fund a program to help safety-net institutions.
Orecki said that using the MCO tax revenue on recurring expenses such as rate increases or budget gaps is “concerning,” as the funds are temporary and don’t do anything to address the root causes of Medicaid spending increases. “Eventually, you are going to run out of that MCO tax money,” he said.
Funds for safety-net hospitals
Hochul’s budget proposal includes more than $1 billion in new funding for safety-net hospitals, which make up 29% of the state’s hospital landscape. Her proposal increases funding for the safety-net transformation program, an effort launched in last year’s budget that aims to incentivize wealthier hospitals to form partnerships with financially distressed institutions to improve their businesses.
The governor proposed a $1 billion allocation for capital projects and $300 million for operating improvements within the safety-net transformation program, the latter of which will come from MCO tax revenue.
The budget also includes $450 million for SUNY Downstate’s University Hospital in East Flatbush, building on an agreement with the legislature last year to devise a plan to ensure the state-run teaching hospital remains financially sustainable. Hochul also allocated $200 million to SUNY Upstate in Syracuse to make capital improvements.
Mental health investments
Following Hochul’s commitment to expand hospitalization for people with mental illnesses last week, the governor proposed to increase beds in state-run psychiatric facilities by allocating $160 million to build a new 100-bed psychiatric forensic unit on Wards Island.
To accompany the shift, Hochul has proposed to change state law to make it easier for police officers and mental health clinicians to involuntarily commit people with behavioral health conditions to psychiatric hospitals, including the bill language in her budget. The governor also allocated $16.5 million to help county governments implement assisted outpatient treatment programs under Kendra’s Law, which requires court-ordered mental health treatment in community settings.